Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV‐1 genital shedding: a prospective cohort study
Open accessAbstract
OBJECTIVE: We sought to examine the impact of the loop electrosurgical excision procedure (LEEP) on the rate and magnitude of HIV-1 genital shedding among women undergoing treatment for cervical intraepithelial neoplasia 2/3 (CIN2/3). DESIGN: Prospective cohort study. POPULATION: Women infected with HIV-1 undergoing LEEP for CIN2/3 in Kisumu, Kenya. METHODS: Participants underwent specimen collection for HIV-1 RNA prior to LEEP and at 1, 2, 4, 6, 10, and 14 weeks post-LEEP. HIV-1 viral load was measured in cervical and plasma specimens using commercial real-time polymerase chain reaction (PCR) assays, to a lower limit of detection of 40 copies per specimen. MAIN OUTCOME MEASURES: Presence and magnitude of HIV-1 RNA (copies per specimen or cps) in post-LEEP specimens, compared with baseline. RESULTS: Among women on highly active antiretroviral therapy (HAART), we found a statistically significant increase in cervical HIV-1 RNA concentration at week 2, with a mean increase of 0.43 log10 cps (95% CI 0.03-0.82) from baseline. Similarly, among women not receiving HAART, we found a statistically significant increase in HIV-1 shedding at week 2 (1.26 log10 cps, 95% CI 0.79-1.74). No other statistically significant increase in concentration or detection of cervical HIV-1 RNA at any of the remaining study visits were noted. CONCLUSIONS: In women infected with HIV undergoing LEEP, an increase in genital HIV shedding was observed at 2 but not at 4 weeks post-procedure. The current recommendation for women to abstain from vaginal intercourse for 4 weeks seems adequate to reduce the theoretical increased risk of HIV transmission following LEEP.
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Tissue specimens were obtained from all treated women, allowing documentation of overtreatment.
“We were able to document the extent of overtreatment in our study because tissue specimens were obtained from all treated women [24, 31, 32].”
From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [31]
The Methods (Study visits and specimen collection; page not available) describe LEEP for participants and collection of cervical secretions for HIV-1 RNA testing, but do not say that excised tissue specimens were obtained from every treated woman. The Methods (Statistical analysis; page not available) identify HIV-1 shedding—not overtreatment—as the study outcome. Searches for tissue histology and overtreatment found no passage documenting either claim. (LLM, conf=0.70)
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Research works printed but not linked: 15
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Rao, S., R, S., Sarma, D., Nath, A., R, A., Jagannathan, L., Rao, A., Suhas, G., Iyengar, S., V, R., et al. (2025) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2025.26.12.4513
“However, there are concerns that in treated WLHIV there may be increased shedding of the virus in women following treatment and increased infectivity [31].”
- Authors
- Huchko, M., Woo, V., Liegler, T., Leslie, H., Smith‐McCune, K., Sawaya, G., Bukusi, E., & Cohen, C.
- Affiliations
- University of California, San Francisco (US)
- Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco San Francisco CA USA
- University of California, Berkeley (US)
- Kenya Medical Research Institute (KE)
- Corresponding author
- Huchko, MJ
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2013-05-07
- Volume
- 120
- Issue
- 10
- Pages
- 1233-1239
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- PMC
- PMC3739995
- OpenAlex
- W2106467116
- Cited by
- 6
- References
- 0
- Citations by year
- 2023: 1 · 2021: 1 · 2017: 2 · 2016: 1 · 2014: 1
- FWCI
- 0.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- University of California, San Francisco-Gladstone Institute of Virology and Immunology Center (P30-AI027763)
- NIH/NCRR/OD UCSF-CTSI (KL2 RR024130)
- International Clinical Research
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Keywords
- loop electrosurgical excision procedure, cervical intraepithelial neoplasia, highly active antiretroviral therapy, HIV risk factors, women living with HIV
- MeSH terms
- Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Cervix Uteri, Electrosurgery, Female, Humans, Kenya, Prospective Studies, RNA, Viral, Sexual Behavior, Time Factors, HIV-1, HIV Infections, Confidence Intervals, Virus Shedding, Viral Load, Antiretroviral Therapy, Highly Active
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